Sunday, August 10, 2008

Disclosure

(**Note: I misunderstood Dr. Shock when I wrote this blog post. He agreed with Dr. X's type of disclosure. Misunderstood or not, his thoughts were the catalyst for my writing about this topic and it felt good to get it all out of my head. Thanks Dr. Shock).

You may have picked up from my blog that I am not only in therapy, but I am also intensely interested in the therapeutic process: The patient/therapist relationship, how that alliance affects therapy and how powerful a catalyst for change and growth a relationship with a trusted therapist can be.

This post is inspired by my curiousity about that process. Recently Dr. Shock has written a series of posts about the Dr./Patient Relationship. They are all very interesting. I find myself both agreeing and disagreeing with one aspect of the Dr/Patient relationship he believes in. He disagrees with a Dr's self-disclosure (in particular when speaking of a psychotherapeutic relationship).

I for the most part agree with him. I think it is important for me as a patient to be able to project my difficult relationship communication problems onto Dr. X. When Dr. X "becomes" my Dad, like in my recent post "Letting Go of the Past", I am able to reflect afterwards and learn from the experience. It is during those moments when I learn the most.

I have had therapists who spent much of my session comparing their problems to mine, telling me everything about themselves. These have never been helpful therapeutic relationships to me. They begin to feel like they turn into therapy for the therapist instead. Dr. X. is not like that. He is very good at limiting self disclosure to almost nothing. While I have an intense desire to know him better, I appreciate that he reveals little to me, he is whoever I need him to be at any given time.

Recently however, he did disclose to me that he has been unwell, and that it appears he has MS. Dr. Shock finds this disclosure uncalled for (**Here is where I misunderstood Dr. Shock' position about Dr. K's disclosure...he actually agreed with Dr. X disclosing his illness ...read his comments and the posts on his site).

Here is where I disagree with Dr. Shock and the following disclosure about my past will explain why. (If you happen to read this Dr. Shock I would be really interested to know how you would manage a situation like this after reading some of why I think this self disclosure was imperative for my well being.)

I have had numerous situations that have intensified my fears of abandonment. The following were probably a few of the things probably the straw that broke this camel's back:

My Dad left my Mom when I was almost 17 years old. I came home from school one day and my Mom as gone. I had no idea why, or where she went. she just disappeared. It was traumatic.

A week later she returned home and suddenly my Dad disappeared. Although I discovered he had moved into his own apartment, again, there was no explanation as to why he left. I was distraught, confused and felt intensely abandoned both times. As the weeks wore on I began to fall into my first depression, but I had no time to help myself, because my Mom was disappearing too, only in a different way.

She began to drink, stopped eating, wouldn't get out of bed all day, began leaving us at night to go drink, lost weight to the point she began to appear anorexic, became so angry she was hard to be around (she is was usually the most calm and compassionate, loving person I have ever encountered). In a word she became severely depressed as a result of my Dad leaving. She desperately needed a job as she had no money of her own.

My Dad had always taken care of us financially. She could not get work, or manage to renew her licensing requirements to become an RN again because she was too sick. When asked my parents if we could see a counsellor, they both responded "it was none of my business. It was between them"

All I knew for years was that my Dad left. I had absolutely no idea why, or why he never came home. He was just gone. I made up all kinds of things in my head..." I was a difficult child, he didn't like me, he couldn't handle my sisters and I, he had just decided one day that he did not want to be with his family, etc." I felt intensely abandoned, sad, lonely, let down, ashamed that I had been such a bad person that I made him leave us. I had destroyed our family.

I felt abandoned by my Dad, but even though my Mom was physically still around, she was gone. She was inconsolable. She was one of those women who married for life. Divorce and remarriage were not options. It was so sad to watch such a beautiful, strong, and loving Mom become nobody without her husband. Without Dad she disappeared into severe depression for at least 10 years and remained moderately to mildly depressed until the year she passed away.

Two years after my Dad left I could not handle the feelings I felt for losing both parents, for not understanding why it had all happened, so I left home to get away from those feelings. I ran.

Four and a half years and three cities later I phoned my Dad and a man answered the phone. Suddenly, it became absolutely clear why my Dad had left my Mom. He was gay. For the first time in years I felt an intense sense of relief and understanding. I finally understood why no one would talk about it. It was the typical shame issue too many people feel about being gay.

Unfortunately, that was not true. My Dad had remarried, and now had a whole new family, a new wife and two sons, without telling any of us. He had left my Mom for a woman he had been dating for a couple years while still living with us. I can't even express the shock, and feelings of betrayal I felt, and to this day feel. My father marries without telling us, allowed us to suffer feelings of abandonment and fear we were the cause of him leaving, when all he could easily have explained what was going on. Maybe not when he first left, but at the very least before he married.

The woman he married was an absolute bitch. I rarely say that abut anyone, but she was the equivalent, and perhaps worse than, the epitome of the evil stepmother. She would draw you in, get you to reveal your souls deepest feelings and then use those to bait my Dad, and to make him angry at us. My little sister used to have to go stay with my Dad very couple weekends. She could hear my Dad's wife yelling at him about how he had to get rid of her. How she did not want my sister there, ever.

She destroyed any hope that my sisters and I could ever have a relationship with my Dad. My Dad has never once mentioned why he left Mom, or even the fact that he did. He never once stood up for us in front of his wife, or any other time tha we know of. Any attempts over the years to talk with him about his leaving and how it affected us ended in our being immediately silenced. This (among other things) left all his children with no ability to have any kind of trusting relationship with him.

What does this have to do with Dr. X's disclosure? Everything. Given I so often, so easily, and so strongly project my father onto him any sudden disappearance on his part, without my understanding why, would cause me to relive those feelings of abandonment, disingenuity, and deceitfulness all over again. Any trust I had in him would be gone, and I am not sure it could ever be regained, especially if I found out he knew, and had known for some time, that he might have to stop work for a while, or "disappear' for a while.

I am working so hard in therapy to learn that I can trust others, that people are genuine, that not everyone will leave me or outright lie to me, or lie to me by leaving out information. It has taken years for me to trust Dr. X. and to begin to feel safe.

On top of my Dad's deceit, and my intense sense of abandonment surrounding the way it all happened, I recently lost my Mom. She had been the only person in my life outside of therapy who really, really supported and understood me and my depression. She became ill with pancreatic cancer and died within 2.5 months of her diagnosis.

I am still having an intensely difficult time dealing with, not just her loss, but the swiftness of her death and the traumatic act of watching her die: watching her try to cling to her children, seeing her try so hard not to abandon us. The intensity of her will to survive, even after she fell into the final throes of death, gasping for air for hours, trying to communicate, when her ability to talk was gone, watching her not wanting to abandon this world and all she loved in it was so traumatic I don't think I will ever recover from the unwilling and unexpected abandonment of someone I loved so much.

Dr. X. needed to tell me he was ill to preserve the integrity and trust in our therapeutic relationship. He needed to show me he valued me enough to be honest and forthright about his potentially needing to cancel, or rearrange appointments. I needed to feel I was important enough for him to be open with me about WHY he was unable to see me; that it wasn't because he didn't want to see me, or because I was a difficult patient, or because he wanted to get rid of me. I needed to know I was not being abandoned and that I would be taken care of in his absence. Dr. X.'s decision to disclose his illness and the potential it had for him possibly needing to take time off work periodically was only decision he could have made given my background and the issues I have been dealing with.

6 comments:

The Silent Voices in my Mind said...

I still think he made the right decision. Given your background, not telling you would have caused more problems than it solved. Even for me, struggling with different issues than you are, I would find it confusing, upsetting and trust-breaking if my therapist suddenly started missing appointments on a semi-regular basis. If it had been obvious he had been having health issues long before this happened - yeah, that wouldn't go over so well. Definate feelings of betrayal...

kara said...

Thank you for sharing so much...honesty and openess I really needed right now. I agree that his decision in opening up that part of his life to you...the part of his life that could effect you was a thoughtful and heartfelt decision as who you are was surely factored in.

Some things we need to know and some of those things are decided by who we are. Yet some things are just a gift of respect. But I do believe a degree of openess is required.

Dr Shock MD said...

The disclosure of your therapist in my post was an example of GOOD use of self-disclosure.
"Several apparent reasons might contribute to the disclosure. MS has an unpredictable course, symptoms might become visible, his patient was worried." I think it is a good example how you can weigh several arguments and use self-disclosure for the benefit of the patient, not for the doctor as in the other example.
May be my limited knowledge of English sorry for the misunderstanding
Regards Dr Shock

Aqua said...

Dr Shock,
It was not you. It was me. Sorry I misunderstood...but it sure gave me lots to think and write about;>) It was helpful for me to get all that out of my head and onto a page. Thanks and sorry for the mix-up,
...aqua

Dr Shock MD said...

It is a very important topic and your right about me not being in favor in self disclosure unless it helps the patient, and has a place within the therapy. It's not meant to help the doctor he will have to get help from others than his patients.

Aqua said...

SV and Kara,
I know he made the right decision. I need to know he will not repeat the pattern my Dad keeps repeating with me.

I have often held back the really personal details of my life, but I think it was important for me to share this. I know many people's parents divorce, and it may seem like a small thing, but it's the way no one allowed, and still, does not allow, us to talk about it,understand it and learn to accept it that causes so much distrust and feelings of being traumatized and retraumatized later in life. The way my Dad dealt and continues to deal with this has impacted every relationship I have ever had. I am trying so hard to stop allowing him to seep into so many areas of my life. You would think at 43 I'd be over it.
...aqua